To enable parents and guardians to authorize the provision of emergency treatment for children who become ill or injured while under the Landon Athletics staff/coaches supervision or under supervision of a volunteer coach, when parents of guardians cannot be reached.

In consideration of being allowed to participate in any way in the Landon Athletics Pole Vault Club and competition, the undersigned:

1. Acknowledge and fully understand that each participant will be engaging in activities that involved risk of injury which might result not only from their own actions, inactions or negligence, but actions, inactions or negligence of others, the rules of play or the condition of the premises or of any equipment used. Further, that there may be other risks not known or not reasonably foreseeable at this time.

2. Assume all the foregoing risks and accept personal responsibility for damages following such injury, permanent disability or death.

3. Release waive and covenant not to sue Maple Valley High School, Landon Athletics, their respective administrators, directors, coaches and other employees of the organization, other participants, all of which are hereinafter referred to as "releasee" from any and all liability to each of the undersigned, his or her heirs and next of kin for any claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise.

Athlete's Name *

Your answer

Athlete's Phone Number *

Your answer

Athlete's Email

Your answer

Address *

Your answer

School/Grade *

Your answer

Gender *

Female

Male

Other:

Athletes Age *

Your answer

Athletes Birthday

MM

/

DD

/

YYYY

Highest Competitive Height *

Your answer

Parent or Guardians Name *

Your answer

Parent or Guardians Phone Number *

Your answer

Parent or Guardian's Email Address

Your answer

Secondary Parent or Guardians Name *

Your answer

Secondary Parent or Guardians Phone Number *

Your answer

Any facts concerning the athlete's medical history, including allergies, medications being taken, and physical impairments. *

Your answer

Agree to follow the safety guidelines of the club and coaches and understand that the signee will be removed from the club if they choose not to follow those safety guidelines.

Agree or disagree below

I, the undersigner, have read the above wavier and release, understand that I have given up substantial rights by signing, and sign it voluntarily. *

Agree

Disagree

I, the parent of the undersigner, have also read the above wavier and realize, and understand that my athlete has give up substantial rights by signing, and sign it voluntarily.

If athlete is under the age of 18 parent or guardian must also sign this document

Agree

Disagree

I give permission for myself, son, and/or daughter to be photographed/Videoed and used in the promotion of www.landonathletics.org web site. I hereby transfer to Landon Athletics pole vault club all copyrights and other interests in the photographs. I also hereby grant royalty-free permission to use these photographs/videos and understand that this material may be used in various publications *